Predictive Value Of Diaphragmatic Potential And Its Derived Parameters For Weaning From Mechanical Ventilatio

BackgroundWeaning from mechanical ventilation is an important step in invasive mechanical ventilation therapy.Timely weaning from mechanical ventilation is crucial for patients recovering from respiratory failure.However,there is still a need for dependable,precise,and practical indicators to help identify people who fail weaning.Increased respiratory drive has been demonstrated to correlate with weaning failure,which could be quantified by electrical activity of the diaphragm(EAdi).EAdi-based parameters may be potential predictor of weaning failure.PurposeWe expect a more significant increase of neural drive in the weaning failure population.And we aim to compare EAdi-based parameters between populations of different weaning outcome to evaluate the performance of EAdi-based parameters as predictors of weaning.MethodThis is a prospective observational study.We studied 35 patients ready for weaning from mechanical ventilation.According to the standardized protocol,the spontaneous respiration test(SBT)was conducted by decreasing pressure support(PS)10 cmH2O to 0 cmH2O with 4-5cmH2O positive end-expiratory pressure(PEEP)unchanged.Respiratory parameters,diaphragm ultrasound,EAdi-based parameters were collected.Patients were divided into weaning failure group and weaning success group according to standardized protocol.ResultsTwenty-two patients experienced successful weaning,while thirteen were classified as having weaning failure.Early increases of EAdi were more pronounced in people with weaning failure.Compared with weaning failure group,the successful group had lower EAdi but higher neuro-ventilatory efficiency(NVE),and neuro-diaphragm excursion efficiency(NEE).At the baseline,NEE performed the best predictive ability with an area under the receiver operating characteristic(AUROC)of 0.874.During the SBT,EAdi-based parameters performed more significant difference and better predictive ability than conventional parameters.Changes in EAdi and neuro-discharge per minute(NDM)at 1 minute were found to provide excellent predictability(AUROC of 0.944 and 0.918,respectively).ConclusionsEarly increase of respiratory nerve drive provides reliable predictive information for weaning outcome.NEE parameter provides valuable information before the SBT.